What is Venous Eczema?
Venous eczema is a common form of eczema that affects one or both lower legs with venous insufficiency. It is also known as gravitational dermatitis.
Who gets venous eczema?
Venous eczema is usually seen in middle-aged and elderly people. It is reported to affect 20% of those over 70 years. It can be associated with:
- History of cellulitis in affected limb
- History of deep venous thrombosis in affected limb
- Varicose veins
- Chronic swelling of lower leg, aggravated by hot weather and prolonged standing
- Venous leg ulcers
What’s Causes Venous Eczema?
Venous eczema occurs due to fluid collecting in the tissues and activation of the innate immune response. During walking, it is normally that the leg muscles pump blood upwards and valves in the veins prevent pooling. A clot in the deep leg veins or varicose veins can damage the valves. Therefore, back pressure develops and fluid collects in the tissues. An inflammatory reaction occurs.
What are the Symptoms of Venous Eczema?
Venous eczema can form discrete patches or it can become confluent and circumferential. Signs can include:
- Orange-brown macular pigmentation due to haemosiderin deposition
- Itchy red, blistered and crusted plaques or dry fissured and scaly plaques.
- Atrophie blanche
- “Champagne bottle” shape of lower leg, which is the narrowing at the ankles, and induration.
What are the Complications of Venous Eczema?
- Cellulitis: it is an infection with Streptococcus pyogenes. It may cause redness, swelling, pain, fever, a red streak up the leg and swollen nodes in the groin
- Impetiginisation: It is a secondary infection with Staphylococcus aureus which resulting in yellowish crusts
- Secondary eczema: It is the eczema spreads to other areas on the body.
- Contact allergy to components of the ointments or creams used.
How to Diagnose venous eczema?
Diagnosis of venous eczema is clinical. You may need to undertake patch tests if there is suspicion of contact allergy.
How to Treat Venous Eczema?
Below are some tips to follow in order to treat/heal the venous eczema:
- Don’t stand for long periods.
- Reduce swelling in the leg
- Elevate your feet when sitting, if your legs are swollen they need to be above your hips to drain.
- Take regular walks.
- Elevate the foot of your bed overnight.
- During the acute phase of eczema, bandaging is important to reduce swelling.
If your eczema has settled, you must wear graduated compression socks or stockings long term. You need also to obtain fitted moderate to high compression socks from a surgical supplies company. Light compression that using travel socks may be adequate, these are easy to put on.
How to Treat the Eczema?
- Oral antibiotics such as flucloxacillin can be prescribed for secondary infection.
- Dry up oozing patches with Condy’s solution or dilute vinegar on gauze as compresses.
- Apply a prescribed topical steroid: You need to start with a potent steroid cream applied daily to the patches until they have flattened out. After a few days, you should change to a milder steroid cream until the itchy patches have resolved. Talk to your doctor to check if you are using steroid creams for more than a few weeks. Be careful, overuse can thin your skin, but short courses of stronger preparations can be used from time to time if necessary to control the dermatitis. You can also use Coal tar ointment.
- Protect your skin from injury
- Frequently, use a moisturising cream to keep your skin on the legs smooth and soft. If your skin is very scaly, urea cream can be especially effective.
How to Treat Varicose Veins?
You need to Seek the opinion of a vascular surgeon regarding an varicose veins. It can be treated surgically, by endovenous laser, or sclerotherapy. Varicose veins may occur again after successful operation because venous disease is progressive.
How to Prevent Venous Eczema?
Venous eczema can’t be prevented but the number and severity of flare-ups can be reduced by the following measures:
- Wear compression socks or stockings
- Avoid prolonged standing or sitting with legs down
- Treat leg swelling
- Apply emollients to dry skin
- Avoid soap and use water alone or non-soap cleansers when bathing